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Updated: Jun 27, 2026

A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
04:30

A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis

Published on: May 14, 2013

Beyond the Stent ("Leave-Nothing-Behind") Drug-Coated Balloons in Acute Coronary Syndrome: A Narrative Review

Sheref Zaghloul1, Ahmed Shahin2, Salaheldin Agamy3

  • 1Cardiology Department, Royal Berkshire Hospital, Reading RG1 5AN, UK.

Journal of Clinical Medicine
|June 26, 2026
PubMed

Insights

Drug-coated balloons (DCBs) offer a viable alternative to drug-eluting stents (DES) for select acute coronary syndrome (ACS) patients, especially those with high bleeding risk. Further research is needed for broader recommendations.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Drug-coated balloons (DCBs) represent a "leave-nothing-behind" approach in percutaneous coronary intervention (PCI).
  • DCBs show potential advantages over drug-eluting stents (DES) in specific acute coronary syndrome (ACS) patient groups.

Purpose of the Study:

  • To review current evidence on DCB therapy for ACS.
  • To compare DCB outcomes with DES in ACS patients.

Main Methods:

  • Narrative review of randomized controlled trials, registries, and meta-analyses.
  • Searched major biomedical databases (PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane CENTRAL) from January 2005 to February 2026.
  • Included studies like PEPCAD NSTEMI, REVELATION, BASKET-SMALL 2, AGENT IDE, REC-CAGEFREE I/II, and TRANSFORM II.

Main Results:

  • DCBs demonstrated non-inferior outcomes compared to DES in selected ACS subsets.
  • DCBs were associated with a reduced risk of major bleeding due to shorter dual antiplatelet therapy (DAPT) duration.
  • Emerging adjunctive technologies like intravascular imaging, AI, and robotic-assisted PCI may enhance DCB performance, but specific ACS evidence is limited.

Conclusions:

  • DCBs are a suitable alternative to DES for selected ACS patients, particularly those at high bleeding risk or with challenging lesion types (small vessels, in-stent restenosis, bifurcations, diffuse disease).
  • Larger randomized trials with long-term follow-up are necessary to support wider adoption and recommendations.

Keywords:
acute coronary syndromeartificial intelligencede novo lesionsdrug-coated balloonin-stent restenosispaclitaxelpercutaneous coronary interventionrobotic-assisted PCIsirolimus

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